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 Development and Evaluation of a Clinical Needs Assessment (CNA) used to Support

Student Nurses and Midwives with a Disability 

Dr S. O’Toole, F. Howlin & Dr P. Halligan

Scoil Na hAtrachta, an Cnaimhseachais agusna gCoras Slainte UCD

UCD School of Nursing, Midwifery and Health SystemsIreland

Introduction & Background

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Background & context

Nature of disabilities

Students with disabilities & third level education

Association for Higher Education and Access Disabilities (AHEAD) (2011)

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Nursing & Midwifery Students Registered with a Disability

1: 19 studentsDyslexia most common Varied types of disabilitiesMore than 1 disabilityUCD/SNMHS* stats:

2010/11 = 49 2011/12 = 51 2012/13 = 46

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*UCD/SNMHS = University College Dublin/School of Nursing, Midwifery & Health Systems

Disability Profile Undergraduate Nursing & Midwifery Students in UCD

2012/2013 – UCD/SNMHS Nursing /Midwifery

Students

Specific learning disabilities 31

Significant ongoing illness 6

Mental health 3

ADD/ADHD 3

Hearing impairment 1

Visual impairment 1

Physical disability 1

Autistic spectrum disorder 0

Other 0

Unspecified 0

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Aim

Present the development and evaluation of a Clinical Needs Assessment (CNA) for

Nursing and Midwifery studentswith a disability in clinical practice

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Phase 1 – Review

Review of current academic needs assessment

Discussion of core competencies: UCD/SNMHS Access centre disability team Key clinical stakeholders Experts who support and advise people with

disabilities (AHEAD & SKILL)

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Phase 2 – Exploration Exploration of the

accommodations Examination of five domains and

standards Identification of core competencies

Explore literature on needs assessments Research literature Disability support services

Refinement of the draft CNA Competencies should not screen out

individuals with a disability

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1. Professional/

Ethical Practice

2Holistic

approaches to care

3Interpersonal relationships

4.Organization

and management of

care

5. Personal and professional development

Domains of Competence

Source: An Bord Altranais (ABA)

The Clinical Needs Assessment

Conducted by Disability Liaison Team

Individualised

Assistive Technology (AT)

Not static

Collaboration

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Clinical Needs AssessmentPart 1

Background

Part 2 Detailed history Reasonable

accommodations

Part 3 (Clinical site) Reasonable

accommodations

Part 4 (Std & Clinical site) Review of reasonable

accommodations

..\..\DSS 2012\CNA\Sample of CNA Part 3.pdf

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Phase 3- Evaluation

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Sample (student profile) Data collection: e-mail,

Interview: (semi-structured, open ended, individual, audio taped)

Ethics – confidentiality and anonymity

Thematic Analyses Key findings:

The Process of Disclosure Supports Environment Personal

Student profile18-21 [school leavers]Female (mainly)Irish Single Type of disability:

Dyslexia = 8 Mental Health =1 SOI=1

Disclosure: 7/10

3 programmes: BSc G, M, P

The Process of Disclosure

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Disclosure

Staff

Personality

Process of Disclosure

I don’t think that the person I was placed with [preceptor], I

don’t think that she knew to be honest. I mentioned it to her a few times but a lot of people say, oh I have a difficulty in

writing and stuff like that. (Int 2)

...when you first go into placement there is so much to take in and

you don't want to single yourself out. (Int 1)

When you are on the ward there isn’t time to

be discussing things like that (disclosure)

(Int 3)

I had a different preceptor almost every day which I found really

difficult because you were constantly explaining to someone

about your difficulties ...(Int 3)

CPC came down and explained to my preceptor that I have a learning disability and when

she left, I was told by the preceptor, yes you have a

learning disability but don’t become a victim about it.(Int

3)

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...you didn't want to, in front of everyone say, well actually I have dyslexia, it might take

me a couple of minutes to catch up. You don't want to be

making an issue of it again. (Int 5)

Process of Disclosure

I found that the forms that we filled out were helpful so the

pressure was taken off me, we didn't have to verbally

disclose, I just handed the sheets and then they could

ask me questions if they needed to... (Int 5)

You are not explaining yourself and getting all

worked up and embarrassed and psyching yourself up to disclose (Int

5)

- I decided to tell them just, ... not to watch my back, ... but say if something did happen at least I would know that I

have told them I have dyslexia (Int 4)

Supports

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Supports

Disability Awareness

Receiving support

Supports

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...she'd [nurse] say a big long word and I'd try and keep repeating it and then someone else might say, oh can you grab this when you are in there as well (Int 4)

...I kind of felt when that [CNA] was done there was a lot of things mentioned that didn't really happen. There wasn’t much put in place if you know what I mean. (Int 3)

...And the nurses were really good like they'd quiz you and you are kind of put on the spot and you feel a bit like, oh oh, when someone is throwing a question at you. You just have to get on with it and its probably better that you have to try (Int 2)

Supports... Definitely the CPCs coming down ... and go through things with me, different clinical issues and stuff

like that that I wouldn't have been aware of before ... she would just

take a bit of time if she had it to go through things. And I just wanted to say it was absolutely fantastic

(Int 3)

I didn't find there was any difficulties as such only when it came to reading... a handover sheet and some of the words I

just hadn't a clue how to pronounce, I didn’t even know

where to start pronouncing them. That would have been difficult.

(Int 4)

I didn’t really have any problems as

far as dyslexia (Int 2)

When I was on placement a few things happened that could have

knocked me back, that could have made me ill again…I got

upset one day in clinical placement and my CPC came to

me and made me a cup of tea and calmed me down and was someone to talk to. And I found that was really, really helpful for

me. (Int 5)I found the support of the other students, knowing someone else was going

through the same thing...really helpful...they can understand what you are saying to them.(Int 5)

Environment

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Environment

Nature of the ward

Documentation

Staffing

Support

Environment

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...they are all so busy and not everyone remembers or whatever...I found in some situations the nurses just didn’t have the time to take us on, and in your first placement, you take a little more time, you know,

you don’t know how to do everything when you first go to the ward. Sometimes the nurses would

be like; oh I will do it, instead of taking the time to teach you or

whatever. (Int 2)

But I found that interview [Occ health] really terrible, it was really stressful... a terrible experience. I came out nearly in tears, it was dreadful... he [DR]was very blunt and not sensitive to my disability.

But at the same time I think what he was trying to do was to see how far he could go before I cracked, to see if I would be able for the pressure of nursing... knock

my confidence and it did take me a while... I was questioning myself again was I actually able for this course, was I

able for this nursing? (Int 5)

I had a different preceptor almost every day which I found

really difficult because you were constantly explaining to

someone about your difficulties and then there was no

consistency about what you were learning and you were nearly starting from scratch

every day …my fault was not really telling people (Int 3)

Personal

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Personality

Communication

Self strategies

Personal

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I'd bring them [list of words] on placement with me so I'd flick through them (Int 3)

...unless you are really confident enough to go up to your

preceptor and say, can I have a word with you, you are not ever

going to be by yourself with her….I never actually got the

opportunity to just say it to her ( Int 1)

you know what you are able to do and what you are not able to do...(Int 1)

At the start though I found the communication with the patients

difficult...because when I was coming from school where you are always looking up to someone else; whereas when you go into

clinical placement, they are looking up to you and they expect you to know; like the roles

have completely shifted (Int 4)

Just don’t want to be making a big issue all the time (Int 3)

Conclusion

The CNA bridges the gap in provision of student support between the academic and clinical environment

The communication re student accommodations between academia and clinical areas requires further improvement

Experience of students were mixed re disclosure and supports received

Environment played a major role in the experience of disclosure and support. Consideration needs to be given to the environment and its impact on these areas.

Recognize that supports are not unilateral but interdependent between clinical, academia and the student

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Relevance to Clinical Practice

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Ongoing disability awareness training for all professionals and incorporate into all education programs. This will ensure that staff are up to date and have the necessary knowledge and skills in providing disability support

Educate students with a disability re the transition to clinical practice (i.e. terminology, word pronunciation, abbreviations)

Improve communications between academic and clinical areas re accommodations and support

Continue to monitor the provision of supports to ensure that students needs are fully met

Seek ways to conduct research into larger populations (i.e. students with different disabilities and from all professions)

Disseminate findings from evaluations to all who support students with a disability

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Thanks to, clinical partners, colleagues and students

Special thanks to AHEAD and UCD Access Centre for their support

Further information:

Frances Howlin 00 353 1 7166563frances.howlin@ucd.ie

Phil Halligan 00 353 1 7166420 phil.halligan@ucd.ie

Acknowledgements

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